How to Identify and Report Child Abuse and Neglect in Delaware

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1 How to Identify and Report Child Abuse and Neglect in DelawareDeveloped by theChild Protection Accountability Commission (CPAC)Abuse Intervention Subcommittee (AIS)c. 2010Script:The following presentation was developed by the Child Protection Accountability Commission’s Abuse Intervention Subcommittee to provide a uniform mandatory reporting training and to help mandated reporters understand the law and their reporting requirements. Additionally, recent legislation increased the need for training statewide. For more information on the Child Protection Accountability Commission and the Abuse Intervention Subcommittee, please go to the Office of the Child Advocate’s Website, which is listed later in this presentation.Speaking points:The Child Protection Accountability Commission or CPAC was legislatively created after the death of Bryan Martin in CPAC members are appointed by the Governor and represent the array of child welfare partners. CPAC is staffed by the Office the Child Advocate.The Abuse Intervention Subcommittee is chaired by the Department of Justice and was created by former Attorney General Charles Oberly to encourage multidisciplinary investigations of child abuse.The Abuse Intervention Subcommittee is also the Children’s Justice Act Task Force. Federal Children’s Justice Act monies target: (1) the investigation and prosecution of child abuse and neglect , particularly sexual abuse and exploitation, (2) the handling of suspected child abuse and neglect related fatalities, and (3) the handling of cases of children with disabilities or serious health-related problems who are victims of child abuse or neglect.Note: A folder of information is provided and referenced during on-site training.

2 Why is it important to identify and report child abuse and neglect?It is important for you to understand how to identify and report child abuse and neglectto keep children safe.Script:Infants, toddlers, and special needs children are the most vulnerable population that we serve. In order to prevent harm to these children, it is important to understand how to identify and report child abuse and neglect. Reporting abuse and neglect may also assist families in receiving necessary services, or it may help disrupt or terminate a cycle of maltreatment.Speaking point:Because infants, toddlers, and special needs children cannot protect themselves they are dependent on the community at large to protect them.22

3 Children are at a higher risk to be abused or neglected if they areBirth to age 6 orDisabled.Script:Children are at a higher risk to be abused or neglected if they are birth to age 6 or disabled. During Federal Fiscal Year 2008, 33% of the child victims were less than age 4 and 15% of the child victims were disabled.(Source for both statistics: DHHS, ACF Child Maltreatment 2008)33

4 How many children are unsafe because they are abused or neglected?National StatisticsIn FFY 2008, child protection agencies received an estimated 3.3 million allegations of child abuse and neglect involving 6 million children. Of those, 23.7% of the investigations determined at least one child was abused or neglected.In FFY 2008, 1,740 children died as a result of abuse or neglect.Source: DHHS, ACF Child Maltreatment 2008Script:In Federal Fiscal Year 2008, 3.3 million reports of abuse or neglect were received by child protection agencies % of those were substantiated or founded for abuse or neglect, and 1,740 children died as a result of child abuse. These are deaths that may have been prevented if the abuse was reported in time.444

5 How many children are unsafe because they are abused or neglectedHow many children are unsafe because they are abused or neglected? (cont.)Delaware StatisticsIn State Fiscal Year 2010, the Division of Family Services received 11,222 reports. Of those, 6,533 (58%) met the criteria for investigation.1,386 reports were substantiated in SFY10.Source: DFS Statistical FY 2010 Fact SheetScript:In Delaware in Fiscal Year 2010, the Division of Family Services or DFS received 11,222 reports of abuse or neglect. 58% of those reports were investigated by DFS and 1, 386 were substantiated.555

6 It is also important to identify and report child abuse and neglect becauseDelaware law requires every citizen in the State of Delaware to reportchild abuse and neglect.Script:Delaware law mandates every citizen in the State of Delaware to report child abuse and neglect.Everyone66

7 Title 16, Subsection 903 of the Delaware Code states:“ Any person, agency, organization or entity who knows or in good faith suspects child abuse or neglect shall make a report in accordance with § 904 of this title. For purposes of this section, "person" shall include, but shall not be limited to, any physician, any other person in the healing arts including any person licensed to render services in medicine, osteopathy or dentistry, any intern, resident, nurse, school employee, social worker, psychologist, medical examiner, hospital, health care institution, the Medical Society of Delaware or law enforcement agency.”.Script:Delaware’s Mandatory Reporting Law was amended on June 30, Not only are all persons required to report child abuse and neglect in Delaware, but agencies, organizations and entities are now required to report. This specifically includes hospitals, nursing homes, and the Medical Society, which means that the employee and the employer will be held responsible for failure to report.When you suspect child abuse and neglect call the child abuse report line at It is not your responsibility to investigate. It is your responsibility to report. Never assume that someone else will report the abuse or neglect. And it does not matter if your reports have not met the criteria for investigation in the past, you still must report.The Department of Services for Children, Youth, and their Families is also obligated to report allegations made against a licensed professional to the Division of Professional Regulation. This Division provides oversight for Delaware’s licensed professionals. A list of the boards/commissions can be found atSpeaking point:Do not assume that another involved professional has made the report even if they tell you they will do it. You are required by law to report and DFS wants to get the perspectives of all involved parties.77

8 Can I be held liable for making a report about child abuse and neglect?16 Del.C. §908 (a) states that“Anyone participating in good faith in the making of a report or notifying police officers pursuant to this chapter, performing a medical examination without the consent of those responsible for the care, custody and control of a child pursuant to § 906(b)(5) of this title, or exercising emergency protective custody in compliance with § 907 of this title, shall have immunity from any liability, civil or criminal, that might otherwise exist, and such immunity shall extend to participation in any judicial proceeding resulting from the above actions taken in good faith. This section shall not limit the liability of any health care provider for personal injury claims due to medical negligence that occurs as a result of any examination performed pursuant to § 906(b)(3) of this title.Script:Delaware law provides for immunity from liability for persons who in good faith report suspected abuse or neglect under the reporting law. The term "good faith" refers to the assumption that the reporter, to the best of his or her knowledge, had reason to believe that the child in question was being subjected to abuse or neglect.88

9 Can anything happen to me if I do not report child abuse and neglect?There is a penalty for not reporting.16 Del. C. § 914. Penalty for violation.Whoever violates §903 of this title shall be liable for a civil penalty not to exceed $10,000 for the first violation, and not to exceed $50,000 for any subsequent violation.(b) In any action brought under this section, if the court finds a violation, the court may award costs and attorneys' fees.Script:Nearly every state imposes penalties on mandatory reporters who fail to report suspected child abuse or neglect as required by law. Delaware’s penalty for violation was changed from a criminal penalty to a civil penalty. The civil penalty for persons or entities who fail to report child abuse is $10,000 for the first violation. The civil penalty for subsequent violations is not to exceed $50,000.Persons, agencies, organizations and entities will be referred to the Department of Justice for investigation if they fail to make mandatory reports of child abuse or neglect.99

10 How do I identify child abuse and neglect?There are physical and behavioral indicatorsfor childrenandthere are parental/caretaker indicators.Script:Now that we understand our obligation to report child abuse and neglect, where to make the report, and the penalties for not reporting, we are going to begin to identify some of the physical and behavioral indicators for children who have been abused or neglected. We are also going to discuss parental indicators. The indicators are “red flags” that alert us to suspect abuse or neglect. You are responsible to report - not to confirm the abuse or neglect occurred before reporting.1010

12 How is child abuse defined in the statute?As defined in 10 Del.C.§901(1), “Abuse” or “abused child” means that the person:Causes or inflicts sexual abuse on a child; orHas care, custody, or control of a child, and causes or inflicts:Physical injury through unjustified force as defined in §468 of Title 11;Emotional abuse;Torture;Exploitation; orMaltreatment or mistreatmentScript:Title 10 of the Delaware Code under Courts and Judicial Procedure defines abuse, as well emotional abuse, exploitation, maltreatment, and mistreatment. These definitions are provided in a separate handout. However, unjustified force will be explained more fully later in this presentation.Abuse is defined as physical injury through unjustified force or any of the other types of abuse listed here. The alleged perpetrator must also have care, custody, or control of the child, which means they are in a position of trust, authority, supervision, or control over the child on a temporary or permanent basis.Sexual abuse of children is also included in this statute, and it will be discussed in more detail later. But unlike physical abuse, sexual abuse does not require care, custody or control for DFS to investigate allegations of sexual abuse against a child. Next, we are going to look more closely at physical abuse.Speaking point:If asked why care, custody, and control is not needed for sexual abuse, the reason is that DFS investigated sex abuse committed by family members, but was unable to substantiate because the alleged perpetrator did not have care, custody or control. Care , custody and control is in the definitions.12121212

13 Child Indicators of Physical AbusePhysical IndicatorsBehavioral IndicatorsHuman bite marksBald spotsUnexplained burnsRope burns on arms, legs, neck or torsoUnexplained fracturesUnexplained lacerations or abrasionsWary of adult contactApprehensive when other children cryBehavioral extremes: Aggressiveness orWithdrawalOverly compliantAfraid to go homeReports injury by parentsExhibits anxiety about normal behavior (i.e. napping)Complains of soreness and moves awkwardlyDestructive to self and othersEarly to school or stays late as if afraid to go homeAccident proneWears clothing that covers body when not appropriateChronic runawayCannot tolerate physical contact or touchScript:Here are some examples of child indicators of physical abuse. A physical indicator is unexplained bruises, whereas a behavioral indicator is a child who is afraid to go home. Please familiarize yourselves with these as they will assist you in identification of child abuse. Generally, these indicators do indicate that a child's safety may be at risk and, at the very least, the situation should be assessed by a professional able to determine the causes of these symptoms and offer the help and assistance necessary to reduce the risk to a child.Speaking point:The indicators are also described in the Professionals Guidebook for Reporting Child Abuse and Neglect (green brochure in your folder).131313

14 Parent/Caretaker Indicators of Physical AbuseOffers conflicting, unconvincing, or no explanation for the child's injuryDescribes the child as "evil," or in some other very negative wayUses harsh physical discipline with the childHas a history of abuse as a childScript:The parent caretaker indicators describe the parent or caretaker’s reaction when confronted with the abuse allegations. It also factors in their parenting style, as well as other issues that may contribute to the parent being abusive or neglectful. For example, a parent may give an explanation that a one month old fractured his or her leg by rolling off the bed. However, the injury is not consistent with the child’s developmental capabilities, so that would be an unconvincing explanation. Infants usually roll over at 3 to 4 months.Speaking point:You can reference A.I. duPont Hospital’s Dr. Dejong who states “Babies that don’t cruise, don’t bruise.” Young children bruise on boney protuberances such as the forehead, knees, shins, and elbows.141414

15 Abuse (non-accidental injury) What is the difference between physical abuse (non-accidental injury) and an accidental injury?Abuse (non-accidental injury)A non-accidental injury has an assignable cause.The injury could have been intentional or unintentional.The injury is a result of force or was inflicted.Accidental injuryAn accidental injury is an injury that does not have an assignable cause.The injury occurred by chance or unforeseen circumstances.Script:Let’s look at the difference between physical abuse and an accidental injury.Abuse is not random and does not occur by chance. It is inflicted and can be intentional or unintentional. External injuries such as burns, bites, and bruises are obviously intentionally inflicted. Unintentional injuries can occur when a parent shakes a child to stop the crying, but the vigorous shaking results in head trauma to the child. The parent likely did not intend to injure the child.An accidental injury is an injury that occurs by chance. Falls are the leading cause of accidental injury for children ages 14 and under (according to the CDC).Non-accidental injuries may be difficult to distinguish from accidental injuries. When in doubt, you should always call the child abuse report line atSpeaking point:An injury or death that was unintentional does not preclude DFS from substantiating child abuse.1515

16 What factors are considered to determine whether an injury is accidental rather than non-accidental?1. Medical examination factors2. Parent/Caretaker factorsScript:Medical examination factors and parent/caretakers factors are used to determine whether the injury is accidental or non-accidental.1616

17 What are the medical examination factors?Location of the injury (e.g., bruise)Mark that looks like an object (e.g. handprint, belt)Injuries discovered during an examinationMultiple injuries in various stages of healingSpecific types of injuries are suspicious for abuse (e.g., blunt force trauma, spiral fracture, retinal hemorrhages)Script:In determining whether the injury was inflicted, the physician will consider the location of the injury, the size and shape of the injury, and the number of injuries. The Division of Family Service’s policy is children under age 9 must receive a medical examination by a physician when there is suspicion of abuse. Children over age 9 may be medically assessed by a nurse or physician’s assistant.Speaking points:The Division of Family Services’ Medical Examination Chart is in your folder.Incidentally, all of the DFS policies and procedures can be found online at their Web address. You will get the Web address later in this presentation.1717

18 Other medical examination factors consider whether:An explanation is offered,the explanation fits the injury; and/orthere was a delay in seeking medical treatment.Script:In addition to the physical examination, the physician will also consider whether the description of how the injury occurred and the appearance of the injury seem plausible. Medical diagnosis by the physician is critical in determining whether the injury was a result of abuse. Additionally, when there is a delay in seeking medical treatment, the physician will take that into consideration as well.1818

19 What are the parent/caretaker factors used to determine whether the injury was non-accidental versus accidental?History of reports and/or investigations by the Division of Family Services (DFS)History of violent offenses recorded in the Delaware Criminal Justice Information System (DELJIS) - including domestic violence or animal abuse, threats of violence, use of weaponsHistory of or current mental health problemsHistory of or current substance abuseScript:Next we are going to look at how the parents or caretakers influence the investigation surrounding the injury. While conducting a joint investigation, DFS and police will consider the family’s history with DFS and whether the parent or caretaker has a history of domestic violence or other violent crimes. DFS and police will also explore whether the parents or caretakers have a history of or current mental health problems or limitations and substance abuse problems.Speaking point:DFS has direct access to DELJIS (this is what the police use on the laptops in their vehicles) and NCIC (National Crime Information Center) information.1919

20 Other parent/caretaker factors include consideration of:Knowledge and attitudes about parenting/caretakingAge of the parent/caretakerFamily stressors – unemployment, financial, social isolation, environmentChild related issues that increase vulnerability – developmental, health, mental health, unwanted childScript:There are other factors taken into consideration when investigating child abuse and neglect. Abuse may be more likely to occur with a teen parent, with a child who has special medical needs, or with a parent that is feeling overwhelmed by child care responsibilities.Speaking point:Examples of an unwanted child: A parent that said they had wanted an abortion, but waited too long.2020

21 What is the difference between discipline and physical abuse?Script:Now that we understand physical abuse indicators, we are going to highlight the distinction between physical abuse and physical discipline.2121

22 Discipline (or training)might simply be defined as a process to help children learn appropriate behaviors and make good choices. In addition, loving, effective discipline aids a child in exercising self-control, accountability, and mutual respect.Through proper discipline, children learn how to function in a family and society that is full of boundaries, rules, and laws by which we all must abide. With it, children gain a sense of security, protection, and often feel accomplishment. Without proper discipline, children are at risk for a variety of behavioral and emotional problems.Source: ALLABOUTPARENTING.ORGScript:Discipline is defined as a process to help children learn appropriate behaviors and make good choices. Discipline teaches children right from wrong and how to learn from their mistakes.For example, a teen is cutting school regularly. As a disciplinary approach the parent may listen to the teen’s feelings and concerns about school. Together, the parent and teen discuss options for addressing the problem.222222

23 What is punishment?Punishment is the practice of imposing something unpleasant or aversive on a person or animal in response to an unwanted, disobedient or morally wrong behavior.Source: WikipediaScript:Punishment, although it may seem interchangeable with discipline, is the practice of imposing something unpleasant or a sanction in response to the problem behavior.For example, a teen cutting school regularly is likely to have their driving privileges revoked, allowance cut, or phone use prohibited.232323

24 Physical Discipline versus Physical PunishmentAs we all know, physical methods can be used to discipline or train a child, as well as to punish a child.So, when does physical discipline or physical punishment become child abuse?Script:Discipline and punishment are also associated with the physical methods, such as spankings. Delaware law does not prohibit physical discipline or punishment.What is the dividing line between discipline and punishment and child abuse?242424

25 Physical Discipline versus Physical Punishment (cont.)Physical discipline and physical punishment becomes physical abuse when the force is unjustified.Delaware law provides guidance for determining whether force is unjustified.Script:Child abuse occurs when the force is unjustified and Delaware law provides guidance for making this determination. It is defined in 11 Del.C. §468.2525

26 Justified Force vs. Unjustified ForceThe use of force is Justified if it is reasonable and moderate and:The defendant is the parent, guardian, foster parent, legal custodian or other person similarly responsible for the general care and supervision of a child, or a person acting at the request of a parent, guardian, foster parent, legal custodian or other responsible person, and:The force is used for the purpose of safeguarding or promoting the welfare of a child, including the prevention of punishment or misconduct; andThe force used is intended to benefit the child, or for the special purposes listed in paragraphs (2)a., (3)a., (4)a., (5), (6) and (7) of this section. These special purposes may involve the use of force by teachers, guardians of an incompetent person, doctors, therapists, wardens, and administrators at the Division of Youth Rehabilitative Services.The use of force is Unjustified if it includes: Throwing the child, kicking, burning, cutting, striking with a closed fist, interfering with breathing, use of or threatened use of a deadly weapon, prolonged deprivation of sustenance or medication, or doing any other act that is likely to cause or does cause physical injury, disfigurement, mental distress, unnecessary degradation or substantial risk of serious physical injury or death.Script:The law differentiates justified force as reasonable and moderate. For example, a parent grabs a child and leaves marks in their efforts to prevent the child from running into the street and getting hit by a car. The parent’s force was justified since it was used to protect the child.Delaware law does prohibit unjustified force. Unjustified force includes: throwing the child, kicking, burning, cutting, striking with a closed fist, interfering with breathing, use of or threatened use of a deadly weapon, prolonged deprivation of sustenance or medication, or doing any other act that is likely to cause or does cause physical injury, disfigurement, mental distress, unnecessary degradation or substantial risk of serious physical injury or death.DFS is required to notify law enforcement of potential criminal violations against a child. Physical marks of abuse may not be present even if the force is unjustified.When determining whether the force used is reasonable and moderate, DFS and the police will consider the size, age, condition of the child, location of the force, and the strength and duration of the force.Speaking points:The list of criminal violations is in your folder.26262626

27 Abusive Head Trauma (Shaken Baby Syndrome)It takes SECONDS of VIOLENT shaking to sustain violent, life threatening injuriesNot typically replicated by anaccidental causeConsidered the perfect crimeScript:Approximately 1400 infants are hospitalized each year as a result of Abusive Head Trauma, formally known as Shaken Baby Syndrome. Of those 1400 infants, 1 in 4 will sustain injuries that result in death. Those infants who survive will suffer from mild to non acute residual effects and/or neurological damage; such as, blindness, seizures, hydrocephalus, hearing loss, cerebral palsy, learning and developmental disabilities, and speech difficulties.Abusive Head Trauma is considered the perfect crime because these non-verbal children are easy victims. Although physical injuries might not be visible on the child, it does not mean that the child is not suffering from internal injuries. Instead, err on the side of caution and if it is alleged that the child was shaken, then take the child to the Emergency Room for further evaluation.

28 SEXUAL ABUSEScript:Previously, we mentioned sexual abuse. Now we are going to talk more in detail about the indicators and the Sexual Predator Act.2828

29 Child Indicators of Sexual AbusePhysical IndicatorsBehavioral IndicatorsDifficulty in walking or sittingTorn, stained or bloody clothingPain or itching in the genital areaBruises or bleeding in external genitals, vaginal or anal areasFrequent urinary or yeast infectionsFrequent unexplained sore throatUnwilling to participate in certain physical activitiesSudden drop in school performanceCrying with no provocationBizarre, sophisticated or unusual sexual behavior or knowledgeAnorexiaSexually provocativePoor peer relationshipsReports sexual abuse by caretakerFear of or seductiveness toward malesSuicide attemptsChronic runawaysEarly pregnanciesScript:As with physical abuse, there are also physical and behavioral indicators of sexual abuse.Early pregnancy and sexually transmitted infections (STIs) must also be mentioned here as possible indicators of sexual abuse. The behavioral indicators are particularly important with sexual abuse cases, because physical evidence may not always be present.292929

30 Parent/Caretaker IndicatorsSexual AbuseIs unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sexIs secretive and isolatedIs jealous or controlling with family members* There is evidence of a relationship between domestic violence batterers and sexual abusers.Script:As professionals, we should consider the possibility of sexual abuse when the parent or caretaker exhibits the characteristics listed here. It is also important to note that there is evidence of a relationship between domestic violence batterers and sexual abusers due to their similar behaviors, which are often seen as controlling, threatening, secretive, self-centered, exploitative, denying and minimizing, claiming loss of control, claiming provocation, building trust during the early parts of their relationship, depersonalizing their victims, creating divisions within the family, confusing love and abuse, manipulation, discrediting abuse disclosures, lack of mental health diagnosis, high recidivism, and resistant to change.Speaking point:Remember, it is not necessary to prove a person had care, custody, or control of a child to make a civil finding or to criminally prosecute for sexual abuse.303030

31 Sexual Predator Act of 1996 (11 Del. C. §771)The intent of this law is to combat teen pregnancy by imposing more severe criminal sanctions on adult males and holding them financially accountable for children born in violation of this law.Script:In recognition of the fact that illicit sexual activity between adult males and teenage girls contributed to the high pregnancy rate in Delaware, this legislation was intended to combat teen pregnancy by imposing more severe criminal sanctions on adult males who are significantly older than their victims and holding them financially accountable when children are born in violation of this law.313131

32 Enhanced Penalties for Crimes Associated with Sexual Abuse of ChildrenTitle 11 of the Delaware Code Relating to Crimes Against Children and Specific Offenses was amended on June 30, 2010 to clarify who is in a position of trust, authority or supervision over a child and to enhance the penalties for committing such offenses.The provisions of the present criminal code concerning rape and unlawful sexual conduct that contain “position of trust” were also consolidated as a single crime known as "sexual abuse of a child by a person in a position of trust, authority or supervision."Script:A person in the position of trust, authority, or supervision is any person who assumes responsibility, whether temporarily or permanently, for the care or supervision of a child or children.The penalties are harsher for those in a position of trust.32

33 EMOTIONAL MALTREATMENTScript:We are going to switch our focus to emotional maltreatment, which includes both emotional abuse and emotional neglect.333333

34 Child Indicators of Emotional MaltreatmentPhysical IndicatorsBehavioral IndicatorsSpeech disordersLags in physical developmentFailure to thriveAsthma, severe allergies or ulcersSubstance abuseHabit disorders (sucking, biting, rocking, etc.)Conduct disordersNeurotic traitsBehavior extremesCompliant, passiveAggressive, demandingOverly adaptive behaviorInappropriately adultInappropriately infantileDelinquent behaviorsScript:Emotional abuse is defined as threats to inflict undue physical or emotional harm, and it may also include chronic or recurring incidents of ridiculing, demeaning, and making derogatory remarks. It is easiest to think of emotional abuse as active. For example, emotional abuse would occur if a parent told the child they were no good or the parent wished they had never been born.Emotional neglect is defined as incidents of isolating/shunning, rejecting, or ignoring a child. Therefore, emotional neglect is more passive and would occur if the parent is generally not interacting with the child or nurturing the child. Domestic violence is also captured under emotional neglect. Later in this presentation, we will touch on domestic violence.Please familiarize yourselves with the child indicators of emotional maltreatment. It is more difficult to substantiate emotional maltreatment since DFS needs to have evidence that the child’s emotional health has been impaired. Therefore, this type of finding is supported by mental health, social work, and counseling professionals working with the child.343434

35 Parent/Caretaker IndicatorsEmotional MaltreatmentConstantly blames, belittles, or berates the childIs unconcerned about the child and refuses to consider offers of help for the child's problemsOvertly rejects the childScript:Let’s discuss what to look for with the child’s parents or caretakers. The parent or caretakers may interact with the child by withholding love, seeing the child as bad or evil, ignoring, blaming, or rejecting the child, feeling unconcerned about the child or unwilling to accept help for the child’s problems.Speaking point:DFS actually breaks emotional maltreatment into separate emotional abuse or emotional neglect findings.353535

37 How is neglect defined in statute?As defined in 10 Del. C. §901 (18) "Neglect" or "neglected child" means that a person:a. Is responsible for the care, custody, and/or control of the child; andb. Has the ability and financial means to provide for the care of the child; and1. Fails to provide necessary care with regard to: food, clothing, shelter, education, health, medical or other care necessary for the child's emotional, physical, or mental health, or safety and general well-being; or2. Chronically and severely abuses alcohol or a controlled substance, is not active in treatment for such abuse, and the abuse threatens the child's ability to receive care necessary for that child's safety and general well-being, or3. Fails to provide necessary supervision appropriate for a child when the child is unable to care for that child's own basic needs or safety, after considering such factors as the child's age, mental ability, physical condition, the length of the caretaker's absence, and the context of the child's environment.In making a finding of neglect under this section, consideration may be given to dependency, neglect, or abuse history of any party.Script:Title 10 of the Delaware Code under Courts and Judicial Procedure defines neglect. As with abuse, the alleged perpetrator must have care, custody, or control of the child. The parent or caretaker must also have the financial means to provide care for the child. Neglect occurs when the parent or caretaker also fails to provide necessary care, which may be food, shelter, or medical care, or the parent or caretaker engages in substance abuse and the abuse impacts the care of the child, or the parent or caretaker fails to provide supervision.Speaking points:Educational neglect/truancy must be reported by the Court. DFS accepts these reports when a parent has not been compliant with court ordered school attendance for his or her child.DFS accepts reports alleging life-threatening medical neglect. This category includes failure by a parent/caretaker to use equipment such as an apnea monitor or respirator, to provide medications for health problems such as diabetes or asthma, or to practice therapies in the home for a child such as suctioning of the airway as directed by a physician for the purpose of preventing death and sustaining life. This finding does not include cases governed by 16 Del. C. §913 (Church of Christ Science).Generally, DFS will not accept a report alleging a parent/caretaker is not giving a child a medication that is not needed to sustain life, but rather to alter the child’s behavior (e.g., Ritalin for ADHD). DFS believes it is the parent’s/caretaker’s choice to administer behavioral medication.373737

38 Child Indicators of NeglectPhysical IndicatorsBehavioral IndicatorsConsistent hunger, poor hygiene, inappropriate dressConsistent lack of supervision, especially in dangerous activities or long periodsUnattended physical problems or medical needsAbandonmentChronic liceDistended stomach, emaciatedBegging or stealing foodConstant fatigue, listlessness or falling asleepStates there is no caretaker at homeFrequent school absences or tardinessDestructiveSchool dropoutEarly emancipation from familyScript;Please review the child indicators of neglect, which includes a child who has been abandoned or who has no caretaker at home. A child left alone in a car is also included in this category.Speaking point:Any time you think a child is at imminent risk of harm or death, such as a baby locked in a hot car, you need to contact 911 immediately before calling the Report Line.383838

39 Parent/Caretaker IndicatorsNeglectAppears to be indifferent to the childSeems apathetic or depressedBehaves irrationally or in a bizarre mannerIs abusing alcohol or other drugsScript:Parents often show signs of current mental health problems or limitations or substance abuse problems in these particular cases.Speaking point:Neglect includes a lack of supervision of the child.393939

40 At what age can a child be left alone?Delaware law does not specify an age when a child may be left alone.Division of Family Services (DFS) policy states a child must be age 12 or older.For any aged child, DFS considers factors such as the child’s level of functioning, maturity, physical and mental health, disabilities, length of time left alone, and the time of day.Script:There appear to be very few states with specific regulations that specify the age a child may be left alone. Delaware has no such law. The general recommendation is that children under the age of 12 should not be left home alone. Nevertheless, for any aged child, the child’s level of functioning, maturity, physical and mental health, length of time left alone, and the time of the day are taken into consideration in determining whether the parent acted appropriately in leaving the child alone. For example, leaving an extremely impulsive 12 year old home alone over night would also be inappropriate.Speaking point:Some organizations train girls under age 12 about babysitting. Be mindful that these situations will be investigated if reported to the Division of Family Services.4040

42 What is a dependent child?10 Del. C. § 908 (8) "Dependency" or "dependent child" means that a person:a. Is responsible for the care, custody, and/or control of the child; andb. Does not have the ability and/or financial means to provide for the care of the child; and1. Fails to provide necessary care with regard to: food, clothing, shelter, education, health care, medical care or other care necessary for the child's emotional, physical or mental health, or safety and general well-being; or2. The child is living in a nonrelated home on an extended basis without the consent and approval of the DSCYF or any agency or court licensed or authorized to place children in a nonrelated home; or3. The child has been placed with a licensed agency which certifies it cannot complete a suitable adoption plan.In making a finding of dependency under this section, consideration may be given to dependency, neglect, or abuse history of any party.Script:Title 10 of the Delaware Code under Courts and Judicial Procedure defines dependency.As with abuse and neglect, the alleged perpetrator must have care, custody, or control of the child. In contrast to neglect, the parent or caretaker does not have the financial means to provide care for the child. Dependency occurs when the parent or caretaker also fails to provide necessary care, or the child is living in a nonrelated home on an extended basis, or the child was placed with a licensed agency that cannot complete a suitable adoption plan.Speaking point:Again, all the definitions are included in your Title 10 handout in your folder.424242

43 Non-Relative PlacementsWhen a child is residing with a non-relative caretaker on an extended basis, it must be reported to the Division of Family Services (DFS) for investigation and approval asrequired by statute (10 Del.C. §908(8)b.2.).Script:Parents may place their children with family members, but they may not place their children with non-relatives on an extended basis without the approval of DFS. The term extended basis is used to suggest that the child resides in the home as opposed to just visiting. DFS will explore the appropriateness of the placement through interviews, a home assessment, and background checks.Speaking points:The Division of Family Services will determine why the child is residing with a non-relative caretaker and if the child can be reunited with family. In addition to the home evaluation of the non-relative caretaker and a criminal background check, the Children’s Department’s database will be searched for any activity.What is an extended basis? One of the keys in making this determination is considering whether the child is “residing” with rather than “visiting” the non-relative. Interviews with the child and parents are crucial to understand why the child is not with parental caretakers. To be clear, DFS must make this determination. You cannot make a decision on your own that the child is staying with a non-relative for an extended visit and not make a report.434343

44 Safe Arms for Babies 1-800-262-9800What is “Safe Arms for Babies”?Safe Arms for Babies is a law that allows a parent to go to any Delaware hospital emergency department and leave their newborn (14 days old or younger) with any emergency department staff or volunteer. This law provides immunity from criminal prosecution for abandonment provided the baby is alive, unharmed and brought into a hospital emergency department.Detailed information, forms, and emergency room locations regarding Safe Arms for Babies can be found at the Division of Public Health’s website:Script:Safe Arms for Babies allows a parent to leave their newborn (14 days or younger) in any Delaware hospital emergency department. They are also given immunity from criminal prosecution for the abandonment of their child.Speaking points:If asked - DFS has not had one case since this law was enacted.If an inquiry is made about recommending this option for mothers with post partum depression the response is: A medical diagnosis is needed for post partum depression. Post partum depression is treatable for many females and males so permanent relinquishment of the child is not the best option.4444

45 Other Things Considered During an InvestigationIn making a determination of child abuse or neglect, DFS will also assess substance abuse and domestic violence occurring in the home.Script:In making a determination of child abuse or neglect, DFS will also assess substance abuse and domestic violence occurring in the home.45

46 Substance AbuseParental addiction is a significant factor in child abuse and neglect cases, with studies suggesting 40% to 80% of families in the child welfare system are affected by addiction. Data indicate that abused and neglected children from substance abusing families are more likely to be placed in foster care and to remain there longer than maltreated children from non-substance families.Source: CWLA National Fact Sheet 2008Script:Child abuse and neglect and substance abuse are inextricably intertwined. An estimated 40%-80% of the 3 million children who come to the attention of the child welfare system each year live in families with substance abuse problems, according to numerous surveys of child welfare agencies nationwide. Additionally, children from substance abusing families are more likely to be placed in foster care and to remain there longer.Speaking point:Substance abuse in and of itself is not considered child abuse. The substance abuse has to impact the child’s care in a negative manner that could be physical or neglectful. For example, a parent may drink a case of beer every weekend, but DFS will not investigate a report alleging only that a case of beer is being consumed. There would have to be a correlation that a case of beer was consumed then the child was battered or the child was left unsupervised or otherwise not cared for properly.464646

47 Substance Abuse (cont.)11 Del. C. § Endangering the welfare of a child; class E or G felony.(5) The person commits the offense of Driving Under the Influence as set forth in § 4177 of Title 21, or the offense of Operating a Vessel or Boat Under the Influence as set forth in § 2302 of Title 23, and during the commission of the offense knowingly permits a child less than 18 years of age to be a passenger in or on such vehicle, vessel or boat.Script:DFS accepts reports alleging Driving under the Influence and Boating under the Influence when a child is present. These types of reports are made by law enforcement.This offense can impact a person’s ability to work in healthcare, childcare, or a public school.474747

48 Drug-Exposed InfantsHospitals should make a report when a mother, baby, or both test positive for substances at birth. The Division of Family Services (DFS) is federally required to develop a plan of safe care for drug-exposed infants.The substances can be illegal or legally prescribed medications that were abused.DFS does not accept reports that allege a mother tests positive for methadone at delivery when it is prescribed by a drug treatment program.Script:DFS accepts reports from hospitals regarding prenatal drug use when an infant or mother tests positive for drugs at birth. The effects of exposure may include low birth weight, premature birth, failure to thrive, and neurobehavioral symptoms. A plan of safe care will be developed which will reduce the child’s risk upon discharge from the hospital.Speaking points: If askedA plan of safe care is not the same as a Safety Plan used by the Division of Family Services to maintain a child safely in the home. A plan of safe care could be services that are offered by the Division of Public Health’s Child Development Watch Program, for example, or services provided by A.I duPont Hospital for Children.If the presenter is questioned further about DFS Safety Plan procedures prior to discharge, please refer the inquiring party to Linda Shannon, Program Manager for Intake & Investigation (302)4848

49 Domestic ViolenceResearch suggests that in an estimated 30 to 60 percent of the families where either domestic violence or child maltreatment is identified, it is likely that both forms of abuse exist.In a national survey of over 6,000 American families, researchers found that 50 percent of men who frequently assaulted their wives also abused their children.Source: Child Welfare Information Gateway – Office on Child Abuse and NeglectScript:Research suggests that in 30 to 60 percent of families where either domestic violence or child maltreatment is identified, it is likely that both forms of abuse exist. In a national survey, researchers found that 50 percent of men who frequently assaulted their wives also abused their children.4949

50 Domestic Violence Abuse IndicatorsExtreme Jealousy Is your partner distrusting and possessive? Does he/she question and "check up" on you excessively?Controlling Behavior Does your partner try to control where you go, what you do, whom you see? Does he/she limit your access to family or friends?Quick Involvement Did your partner come on like a whirlwind, demanding quick commitment?Unrealistic Expectations Does your partner depend on you to meet all needs? Are you expected to be the perfect spouse, parent, lover, friend?Isolation Does your partner try to cut you off from resources, limit your contact with family and friends, prevent you from going to work or school?Blames Others for Own Problems Does your partner blame you for personal problems, instead of taking responsibility?Cruelty to Animals or Children Does your partner act brutally to animals, tease children excessively, expect them to do things that are beyond their capability?Abuse of Sexual Intimacy Does your partner manipulate or coerce you into having sex or performing specific sexual acts when you don't want to?Verbal Abuse Does your partner say things that are cruel and hurtful, put you down, minimize your accomplishments?Rigid Gender Roles Does your partner hold rigid beliefs about male and female roles within a relationship, and demand that you comply?Jekyll/Hyde Does your partner have an explosive temper, sudden mood swings? Behave kindly in public but cruelly in the privacy of your home?Source: Alabama Coalition Against Domestic ViolenceScript:We mentioned several of these indicators earlier in this presentation when we were reviewing sexual abuse. However, it is important to reaffirm the similarities between sexual abuse and domestic violence perpetrators.505050

51 Domestic Violence11 Del. C. § Endangering the welfare of a child; class E or G felony.(4) The person commits any violent felony, or reckless endangering second degree, assault third degree, terroristic threatening, or unlawful imprisonment second degree against a victim, knowing that such felony or misdemeanor was witnessed, either by sight or sound, by a child less than 18 years of age who is a member of the person's family or the victim's family.Script:Any individual who commits felony or misdemeanor level domestic violence that is witnessed by a child, either by sight or sound, can also be charged with endangering the welfare of a child, a class E or G felony.Speaking point:Law enforcement should make a report to the Child Abuse Report Line upon charging.5151

52 Reporting Child Abuse and NeglectWhat is my role after a child discloses abuse or if I have a reasonable suspicion of abuse or neglect?Script:What is my role after a child discloses abuse or if I have a reasonable suspicion of abuse or neglect?Your role is to make a report to the Child Abuse Report Line.5252

53 Child Disclosure of AbuseThree do nots:Do not interview the child multiple times.Do not take pictures of the injuries or ask the child to undress. (Exception – medical providers)Do not notify the parent/caretaker you are making a report.Script:The child should not be interviewed beyond the disclosure.To reduce the trauma to the child, interviews will be conducted by the multi-disciplinary team. This team will be identified later in the presentation.Speaking points:Only obtain enough basic information to make the report: (1) how the child was abused or neglected (type such as physical or sexual) or why the child is afraid he or she will be abused or neglected, (2) who is the alleged abuser, and (3) when the alleged abuse occurred.Questioning the child beyond obtaining basic reporting information or questioning a child more than once could prevent DFS, law enforcement, the Department of Justice, and the Children’s Advocacy Center from conducting an effective investigation and hinder a civil substantiation or criminal prosecution.535353

54 How do I make a report? Se Habla Español!To report suspected child abuse or neglect in Delaware call the 24 Hour Division of Family Services (DFS) Report Line atDelaware’s 800# is a national and statewide number. Reports should not be made to local DFS offices.Spanish translation is available to make a report during the weekdays from 8:00 a.m. to 3:30 p.m.DFS also accepts written reports and walk-in reports.Script:All suspected child abuse and neglect in the state of Delaware must be reported to the child abuse report line at Even when you know the case is active with DFS and further abuse or neglect is suspected you must call the child abuse report line.Obviously, when a child’s life is in danger, you should call 911 immediately.Speaking point:DFS also receives reports from hearing impaired individuals via agencies that have TTY capability.Se Habla Español!545454

55 Report Line Magic words are “I want to make a report.”If unsure, DFS needs to be the decider. It’s okay to call the Report Line and discuss what you know.DFS may have information about the family you don’t know about.You will be informed at the time of your call whether the report has been accepted or not for investigation or you should receive a call back within 24 hours, if you provide your name.Script:Every report is reviewed by a DFS Report Line Supervisor. If informed that your report does not meet criteria for investigation and you continue to have concerns, you should ask to speak to a report line supervisor. The Report Line worker is required to give his or her name if you request it, as well as their supervisor’s name.Speaking point:The phone numbers for the Report Line Supervisors has been included in your folder.555555

56 What if I want to make a report anonymously??A reporter does not have to provide identifying information to the Report Line. However, it is DFS policy to never reveal the source of the report to the party being investigated.Nevertheless, DFS may be required to provide reporter information to law enforcement, the Department of Justice, or the Courts.Script:Please understand that as a mandated reporting entity, when there is no reporting source there will be no way to confirm that you fulfilled your responsibility to report.Speaking points:Once you give DFS your name, you are no longer anonymous. Nevertheless, DFS will still not divulge that you made the report. It is helpful to have the reporter’s name and contact information in case DFS or law enforcement has additional questions.It is not uncommon for the party under investigation to tell other people that DFS told them the reporter’s name. They are doing this so they can find out who made the report.5656

57 As a medical provider, how do I know I am not violating HIPAA when I make a report?The reporting of child abuse and neglect is not precluded by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Federal and HIPAA rules do not apply where “the provision of State law, including State procedures established under such law, as applicable, provides for the reporting of disease or injury, child abuse, birth, or death, or for the conduct of public health surveillance, investigation, or intervention.” HIPAA (1) Section (c)Script:HIPAA does not preclude reporting suspected child abuse.Speaking point:Remember, there is a penalty for not reporting child abuse and neglect.575757

58 What information is needed to make a report?DemographicsDescribe the abuse or neglect or why the child is at risk of CANKnown information about the parents or siblingsKnown information about the alleged child victim’s physical health, mental health, educational issues or parents or siblingsIs the alleged child victim in need of medical attention for injuries?Known information that could put the child’s or worker’s safety in peril such as the presence of alcohol, drugs, weapons, dangerous animals, or criminal behavior* More information is better than less!Script:The information you provide when making a report assists DFS in determining whether the report meets criteria for investigation and when it does - how quickly to respond.5858

59 The Division of Family Services Report Line 1-800-292-9582Calls are digitally recorded for random quality assurance reviews.By statute, there is no liability for reporting.The person who spoke to the child or observed the child should make the report because it is required by statute and the Report Line may have questions about the child’s disclosure or condition.Script:The report should be made by the person who spoke to or observed the child, because the report line may have additional questions.Speaking point:Regarding quality assurance, DFS Supervisors and most DFS administrators are assigned random cases to review on a monthly basis. This also includes rejected reports.595959

60 Script:In addition to making the report, professionals should complete the Mandatory Reporting form. The form can be found online at the DFS website.Speaking points:This slide only shows the front page of the form. It should be completed and mailed to the address on the front of the form within 72 hours after making the report. This form provides DFS with additional documentation about the report.The form can also be used as a guide when making an oral report. The front page contains the demographic information and the back page is where you will describe the abuse or neglect. Diagrams are also available on the back page for medical professionals to document injuries.A copy of the form is in your folder.NOTE: The form and this slide will be updated to include the responsibility of the entity to report.606060

61 The Division of Family Servicesreceives reports for all children in the State of Delaware that have been abused or neglected.Then DFS will do one of three things:1.) accept the report and investigate the allegations;2.) refer the report to law enforcement for investigation; or3.) reject the report.Script:The Division of Family Services receives reports for all children in the State of Delaware that have been abused or neglected. Upon receipt of the report, DFS will do one of three things: accept the report and investigate the allegations; refer the report to law enforcement for investigation; or reject the report.Speaking point: If askedThere are three criteria for investigation of a report:Report involves a child from birth to age 18Report alleges child abuse, neglect or dependency or risk thereofReport alleges intrafamilial or institutional abuseIntrafamilial and institutional abuse are defined in Title 10 of the Delaware Code that discusses Family Court. The definitions are included in your folder.

62 Multidisciplinary Response to ReportsDFS and law enforcement will conduct a joint investigation for any report that involves a crime against a child.The Department of Justice (DOJ) will decide if there is enough evidence to prosecute criminally or civilly.Whenever appropriate, cases will also be referred to the Children’s Advocacy Center (CAC) for a forensic interview, medical exam and/or mental health screening.Script:Children are best served when there is collaboration among the entities investigating child abuse and neglect.62

63 How can information be shared?In general, DFS will share information only when there is a signed release of information (informed, time limited consent).DFS, law enforcement, the CAC, and the DOJ exchange information on families and children when this information is needed to assist an investigation involving a shared client.Script:DFS will share information when there is a signed release of information. However, the multidisciplinary team will exchange information when it is relevant to an investigation involving a shared client.Speaking points:If you have already made a report that was accepted for investigation and need to speak to the caseworker, but do not know the caseworker’s name, call the Report Line and leave your name.If you know the name of the caseworker, call them directly.A new abuse or neglect incident requires a new report to the 800#.636363

64 Other Useful InformationScript:Now we would like to discuss some other types of abuse or neglect that are potential warning signs of child abuse or neglect.6464

65 Child abuse and neglect is also related to other types of abuse such asAnimal AbuseElder AbuseChild TraffickingAdditionally, studies have shown a strong correlation between each of these types of abuse.Script:Animal abuse, elder abuse, and child trafficking have a strong correlation with child abuse and neglect.6565

66 Animal AbuseA study of 45 violent inmates in Florida prisons and 45 prisoners serving time for drug and property offenses found more than half of the violent offenders had committed animal cruelty as children. By comparison, just 20 percent of the nonviolent offenders had a history of attacking animals. (The Associated Press, February 29, 2004)Teenage boys who are slapped, spanked or hit by their fathers can be more than twice as likely to abuse animals. A substantial number of teenagers who committed mass murder at their schools—nearly half in one study—were more likely to have abused animals. (The Plain Dealer, January 7, 2002)Interviews with more than 100 U.S. serial killers showed that most had a history of some form of animal abuse in their childhoods. (BBC News, November 22, 2001)Script:Studies have shown that serial killers or other individuals who have committed mass murders have a history of animal abuse during their childhood.666666

67 Physical Indicators of Elder Abuse and NeglectInjury that has not been cared for properly.Any injury incompatible with person’s explanation.Pain on touching.Cuts, lacerations, puncture wounds.Bruises, welt, discoloration:On both upper arms.Clustered on trunk, but may be found over any area of the body.Injury looks like an object.Presence of old and new bruises at the same time.Dehydration and/or malnourishment without illness-related cause; loss of weight.Pallor.Sunken eyes, cheeks.Evidence of inadequate care (i.e., gross decubitus without adequate medical care).Evidence of inadequate or inappropriate use of medication.Absence of hair and/or hemorrhaging below scalp.Soiled clothing or bed.Burns – may be caused by cigarettes, caustics, acids, friction from ropes or chains; from confinement.Signs of confinement (tied to furniture, bathroom fixtures, locked in a room).Lack of bandages on injuries or stitches when indicated, or evidence of unset bones.Script:Please note the similarities between physical, behavioral, and family or caretaker indicators of elder abuse to child abuse and neglect.If asked -Source for Slides 67-69: Adapted from Consortium for Elder Abuse Prevention Protocols, Coalition of Agencies Serving the Elderly, San Francisco, California.Distributed by Judith L. Warren, Ph.D., Extension Program Leader–FDRM, Professor and Extension Gerontology Specialist, Texas AgriLife Extension Service, Texas A&M System, College Station, Texas.676767

69 Indicators from the Family/CaretakerThe older person may not be given the opportunity to speak for him or herself or to see others without the presence of the caregiver (suspected abuser).Obvious absence of assistance, attitudes of indifference or anger toward the dependent person.Family member or caregiver “blames” the older person (i.e., accusation that incontinence is a deliberate act).Aggressive behavior (threats, insults, harassment).Previous history of abuse to others.Problems with alcohol or drugs.Flirtations, coyness, etc. as indicators of possible inappropriate sexual relationship.Social isolation of family or isolation or restriction of activity of the older adult within the family unit.Conflicting accounts of incidents by the family, supporters, victim.Unwillingness or reluctance to comply with service providers in planning for care and implementation.Withholding of security and affection.No scriptSpeaking point:Occasionally, DFS and the Division of Services for Aging and Adults with Physical Disabilities conducts investigations for both issues within the same family.696969

70 Indicators of Child TraffickingEvidence of abuse (physical, mental, or sexual)Employer is holding identity and/or travel documentsWorking unusually long hoursUnpaid or paid very littleNot in school or significant gaps in schooling in the U.S.Living at workplace with employerLiving with multiple people in a cramped spaceHeightened sense of general fear (for self and family/unusual distrust for law enforcement)Inability to speak to child aloneEngaged in prostitution or induced to perform a commercial sex actSource: Lutheran Immigration and Refugee ServiceScript:Although it’s not widely recognized, child trafficking is an emerging concern in Delaware and nationally.Speaking point:As you can see, when one type of abuse or neglect is present, you need to be aware that other types of abuse or neglect may also be present.707070

71 Helpful State of Delaware Web SitesDepartment of JusticeDepartment of Services for Children, Youth and Their Families (DSCYF)* Division of Family Services (DFS)Office of the Child AdvocateChildren’s Advocacy Center of DE, Inc. (CAC)Script:Finally, here’s a list of useful State of Delaware websites, which provide additional information and resources related to child welfare.Thank you for taking the time to participate in this training that will increase awareness of reporting child abuse and neglect.7171

72 Questions? When? Who? Where ? What ? Why? How? 72 72Presenters – Do not discuss specific Division of Family Services cases in front of the entire audience. If an attendee wants to discuss a specific case, ask them to contact Kriston Lowry-Sims whose number is included in their phone number list. Kriston handles constituent relations for the Division.7272